Fixing a Broken Heart

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Heartbreak is real. What we commonly regard as heartbreak, or more generally as depression, is a very real condition, one with physiological manifestations that may lead to more serious conditions. However, as two practicing psychiatrists reveal, bouts of depression may not have been caused by heartbreak, but were actually triggered by it.

“[Depression] is not something that a patient imagines,” said psychiatrist Dr. Charibel Escandelor. This is true especially in cases of clinical depression. “Hindi sila umaarte lang (They are not putting on a show) to ask for attention or get to back the lost love. It is a physiological phenomenon that happens in the brain,” she said.

Understanding Depression

Understanding how depression works became possible only with recent technology such as Functional MRI and PETscan, which allowed scientists to observe the brain more thoroughly. Neuroscience research has showed that feelings of depression manifest in the way the brain functions. Certain substrates, like the “brain food” glucose will be used by it in a different way, some areas of the brain will be hypo-functioning while other areas will be hyper-functioning, brain cells begin to lose contact with each other, and the passing of information becomes inefficient. “The brain cells die. Among people with chronic depression, it has been found in studies that some areas of the brain actually shrink in volume,” she said.

It can happen that patients come to seek help not because they are feeling sad, but because seemingly innocuous conditions (such as recurring headaches or gastric problems) cannot be explained clearly by routine lab work. When a patient is diagnosed as depressed, there is also the mistake of attributing it to just one cause. “Upon further exploration, there are other things going on and the relationship was just a trigger,” said Dr. Monina Garduno-Cruz, the head of the psychiatric section of St. Luke’s Medical Center Quezon City.

Sad Trip

First, one has to understand that feeling low and being sad is not the same as being clinically depressed. The latter involves experiencing a cluster of symptoms used by psychiatrists to diagnose a person suffering from depression. These symptoms include loss of interest in things the patient used to enjoy; a lack of drive or enthusiasm; sleeping too much or not at all; appetite problems; weight loss or gain; lack of energy/lethargy; and psychological symptoms such as a preoccupation with guilt, pessimism, feelings of hopelessness and even suicidal thoughts. These symptoms do not change according to the cause of the depression.

Dr. Cruz said that depression related to heartbreak may actually be an adjustment disorder. Because a breakup usually entails changes in routine or lifestyles, one may actually be having difficulty in adapting to this change and thus are experiencing depression because of it.

Nevertheless, there are people who tend to be very vulnerable to depression due to a breakup, and that the breakup may trigger a major bout of depression. Of the cases of depression she has handled, Dr. Cruz said that about 15 per cent can be attributed to failed romantic relationships.

Treatment Options

Milder forms of depression, said Dr. Cruz, can be treated through talk therapy, which does not entail the help of a psychiatrist and can instead be handled by a counselor, a life coach or a psychologist.

Major depression needs medication (such as anti-depressants) and therefore needs the help of a psychiatrist. Major depression happens when the condition gets in the way of the patient’s ability to function normally: a mother, for example, being unable to care for her children, an employee having difficulty performing at work, or a normally functioning person suddenly withdrawing from friends.

Nevertheless, it is important to spot depression, even a mild one, and seek help. Left untreated, the patient is at risk of going through repeated bouts in the future. “And there are patients who actually never get out of depression,” said Dr. Escandelor. These patients end up suffering from a persistent depressive disorder called dysthania, wherein the patient experiences depression for longer periods, even years. Those who suffer from dysthania tend to have a more difficult time when major depressive bouts come along.

Extreme cases of depression can sometimes lead to suicidal tendencies. The flags for these cases include talking about feelings of hopelessness, lack of purpose, and having no reason to live. Sometimes, it can be as plain as verbalizing the wish to die. What makes these suicidal tendencies more alarming is the access to firearms or a history of substance abuse, which can exacerbate the situation by impairing judgment.

Healing Process

Dr. Escandelor observes that there are patients who have the ability to reflect on their behavior. Patients who get better tend to have had at least one healthy relationship in the past and are able to reconnect with that experience.

How long a patient recovers depends on the patient himself; some stay in denial, while some do not want to accept their role in getting better.

“When a relationship fails, what we should always remember that it’s never just the fault of a single person … You can’t take all the blame, but you can’t put all the blame on the other person, either,” Dr. Cruz said.

Sadly, there are only a handful of psychiatrists currently practicing in the Philippines. Short-term psychotherapy usually involves 12 to 24 sessions, and some psychoanalytic kinds of psychotherapy can take years. In the Greater Manila Area, rates can range from Php1,000 to Php2,000 per consultation, and it is only slightly more affordable in the provinces. Patients, however, can set goals and aim to get better in as short as two to four months; psychiatrists can help them achieve this goal.

How quickly a patient recovers depends also on how soon they come to seek help. So the sooner they seek help, the less there is to fix, so to speak.

“Move On”

Sometimes, patients do not come to psychiatrists because of the stigma associated with seeking professional help, or because they consider the situation a “pagsubok”, or a personal challenge. “They also see [depression] as a weakness in character, which it is not,” said Dr. Escandelor.

Until they are able to seek help, the depressed can instead go to a counselor or a priest or a friend, preferably those with a background in psychology. They can also go to Internet resources that have professionally curated information and educate themselves about depression.

However, Dr. Cruz warns well-meaning friends to go easy on the broken-hearted and not simply tell them to “move on.”

“Listen to your friend, help her process the situation … Find out her feelings and then validate the feelings,” she said. Seeing the situation from the person’s perspective also helps. “Maybe to you, it was not a big deal, but for that person, it hurt a lot,” she said.

“Say ‘move on’ only after you’ve done all these things and she still keeps on bringing up the heartbreak. But you can’t say ‘move on’ at the outset. She has to be heard first,” said Dr. Cruz.